Financial barrier to lung cancer screening comes down

The U.S. Preventive Services Task Force is now recommending that older Americans with a smoking history that puts them at risk for lung cancer undergo an annual low-dose CT screen.

The recommendation by USPSTF — a powerful, government-appointed panel of experts that advises Congress on health practices — is based on evidence from the National Lung Screening Trial that showed lung cancer can be detected by a CT screening at an early stage while it is still curable with surgery.

While the recommendation is in draft form and open for public comment until Aug. 26, it is highly unlikely that final recommendations will contain any major changes, according to experts.

"It might be tweaked a bit, but that's all," said Dr. Andrea McKee, chair of radiation oncology and director of the Lahey Hospital and Medical Center's "Rescue Lung, Rescue Life" program, which has screened about 1,300 smokers and ex-smokers for free, since neither the government nor most private payers has covered the cost.

Some Massachusetts hospitals, including HealthAlliance in Leominster and Milford Regional Medical Center, have already been offering CT screening for high risk patients on a self-pay basis. However, the price, which can reach as much as $450, has resulted in few takers.

The task force's recommendation "eliminates the financial barrier to screening," according to Dr. Max Rosen, chairman of the radiology department at UMass Memorial Medical Center, which plans on rolling out its own CT screening for lung cancer program in the fall.

The task force's final approval, expected this winter, would pave the way for Medicare and Medicaid to cover the cost of the screening, without a deductible or co-payment, just as it does now for screening procedures for three other cancers: breast (mammography), colorectal (colonoscopy) and cervical (Pap smear).

Private insurers usually cover a procedure once Medicare decides to pay for it, according to Dr. McKee. And under the Affordable Care Act, private insurers writing new policies are required to cover all preventative screenings for cancer recommended by USPSTF.

The national lung cancer screening trial, which ran from 2002 to 2011, involved 53,000 men and women, current and former heavy smokers, age 55 to 74, who had a smoking history of at least 30-pack years (an average of a pack-a-day for 30 years or two packs a day for 15 years, etc.).

If you were a former smoker you had to have quit smoking within the previous 15 years, a period of time when you are still at high risk for lung cancer. "The longer you go without smoking, the less risk there is for lung cancer," said Dr. McKee. "It doesn't become zero, but the risk does decline."

Each participant in the trial was randomly selected to receive either CT scanning or a chest X-ray each year for three years. The results were favorable, showing that CT screening reduced the death rate by lung cancer by 20 percent more than chest X-rays.

Age is the one difference between the USPSTF criteria for patients and the criteria for participants in the national trial. USPSTF would extend the upper age of the individuals to be screened from 74 to 79. "We know that the average age for diagnosis of lung cancer is 71, so that's why they expanded that upper age limit," said Dr. McKee.

About 7 million smokers in the U.S. fit the original criteria set for the lung cancer trial, but it's not known how many more people would be eligible because of the increase in the upper age cutoff.

How many prospective patients would show up for an annual CT screening for lung cancer is anybody's guess, according to Dr. Rosen, who pointed out that since it was recommended several years ago that patients over age 50 undergo a colonoscopy screening for colorectal cancer, fewer than 50 percent of the millions of people in that age group have actually had a colonoscopy done.

"There are a lot of people who really don't want to know," Dr. Rosen said. However, he added that the task force's recommendation "will encourage more doctors to advocate for the CT screening for their patients."

Screening patients who are still smoking may also give them a reason for quitting, according to Dr. Rosen. "When you show smokers images of their lungs, it can be very motivating."

Lung cancer kills about 157,000 Americans annually, more than breast, colorectal and prostate cancers combined. Currently, only about 15 percent of men and women diagnosed with lung cancer survive five years. About 85 percent end up with lung cancer written on their death certificates.

"We would like to see a reversal of those percentages," said Dr. Ciaran McNamee, chief of thoracic surgery at Milford Regional Medical Center and a thoracic surgeon on the staff of Brigham and Women's Hospital.

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